Georgia § 33-46-23-1 Prior authorization of prescription medications for chronic conditions

Georgia Statutes

§ 33-46-23-1 — Prior authorization of prescription medications for chronic conditions

(a)As used in this Code section, the term:

(1)"Chronic condition" means a serious, long-term, physical, mental, or developmental disability or disease.

(2)"Ongoing medication therapy" means a clinical and evidence-based treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for at least a year.

(b)Unless otherwise provided in subsection (c) of this Code section or prohibited by state or federal law, if a healthcare provider receives a prior authorization for a medication prescribed to a covered person with a chronic condition that requires ongoing medication therapy, and the provider continues to prescribe the medication, and the medication is used for a condition that is within the

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(a) As used in this Code section, the term: (1) "Chronic condition" means a serious, long-term, physical, mental, or developmental disability or disease. (2) "Ongoing medication therapy" means a clinical and evidence-based treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for at least a year. (b) Unless otherwise provided in subsection (c) of this Code section or prohibited by state or federal law, if a healthcare provider receives a prior authorization for a medication prescribed to a covered person with a chronic condition that requires ongoing medication therapy, and the provider continues to prescribe the medication, and the medication is used for a condition that is within the scope of use approved by the United States Food and Drug Administration or has been proven to be a safe and effective form of treatment for the patient's specific underlying condition based on clinical practice guidelines that are developed from peer-reviewed publications, the prior authorization received shall: (1) Be valid for the lesser of: (A) One year from the date the healthcare provider receives the prior authorization; or (B) Until the last day of coverage under the covered person's healthcare plan; and (2) Cover any change in dosage prescribed by the healthcare provider during the period of authorization. (c) (1) This Code section shall not apply to: (A) Medications that are prescribed for a nonmaintenance condition; (B) Medications that have a typical treatment period of less than 12 months; (C) Medications for which medical or scientific evidence does not support a 12 month approval, including medications where an initial shorter duration approval is necessary to demonstrate appropriate response to therapy; or (D) Medications that are opioid analgesics or benzodiazepines. (2) Nothing in this Code section prevents the prior authorization of a medication for more than a year if permissible by the covered person's healthcare plan.

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